Academic journal article Ethical Human Psychology and Psychiatry

It Is Time to Rename the DSM

Academic journal article Ethical Human Psychology and Psychiatry

It Is Time to Rename the DSM

Article excerpt

Although the DSM purports to be a theoretical with respect to the etiology of mental disorders, its fundamental assumption that aberrant patterns of thought, emotion or behavior reflect mental disturbance is itself an unjustifiable a priori position. Within the DSM-IV-TR, the existence of compelling dysfunctional psychosocial etiological influences precludes the diagnosis of conduct disorder. Consistent with this precedent, the following principle needs to be expanded to virtually all the conditions found in the DSM: "Conditions reasonably attributable to psychosocial factors or medical conditions should not be considered mental disorders." Following this principle could cause the very concept of mental disorder to evaporate, in favor of a nondualist perspective on explaining human behavior in favor of a consistently physicalistic one. This would promote the study of dysfunctional behavior as a legitimate field of natural science and not one of metaphysical enquiry.

Keywords: DSM; psychiatric diagnosis; mental disorders

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been in existence for over 50 years. From its initial conceptualization it contained an inherent flaw that has been rendered so conspicuous in its most recent edition, the DSM-IV-TR (American Psychiatric Association, 2000) that it is time to rename and revise the document in favor of one more centrally placed within the sphere of the nature science. This flaw consists of the central paradox that the DSM describes mental disorders, while at the same time contending that the manual provides "a descriptive approach that attempted to be neutral with respect to theories of etiology" (APA, 2000, p. xxvi). However, this glosses over the fact that labeling the DSM as a nosology of mental disorders is itself a theoretical (e.g., explanatory) position, namely that these conditions are etiologically based in disorders of the mind, and indeed reside in the patient's mind.

This assumption is taken as an a priori given, with no critical consideration to alternative positions. The second page of the DSM's introduction asserts that "The need for a classification of mental disorders has been clear throughout the history of medicine . . ." (APA, 2000, p. xxiv, italics added). While a systematic approach to categorizing unusual or problematic behavior is certainly needed, by initiating the discussion with the contention that these are mental phenomena, all subsequent exegesis is colored by this perspective. Consider the current DSM definition of mental disorders:

. . . each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, this syndrome or pattern must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one. Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual. Neither deviant behavior (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual, as described above. (APA, 2000, p. xxxi, italics added)

The above paragraph is indeed a modest framework to erect the substantial edifice of the DSM. The points of contention leading to the title of this article are those words italicized in the above definition, namely "in the individual . . . whatever its original cause." I am not arguing here that unusual or dysfunctional behavior does not exist. It does and it is an appropriate focus of disciplines such as psychiatry, clinical psychology and clinical social work. …

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